A nurse held a baby while his mother, who complained of flulike symptoms, was being checked by doctors at a hospital in Oaxaca yesterday. Oaxaca, which is one of Mexico's poorest states, has reported about 60 suspected cases of swine flu. &#160; (Adriana Zehbrauskas / New York Times News Service)

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A nurse held a baby while his mother, who complained of flulike symptoms, was being checked by doctors at a hospital in Oaxaca yesterday. Oaxaca, which is one of Mexico's poorest states, has reported about 60 suspected cases of swine flu. (Adriana Zehbrauskas / New York Times News Service)

OAXACA, Mexico – Adela María Gutiérrez fell ill April 1 with what she thought was a bad cold. She tried aspirin and antibiotics, bed rest and moist towels, but nothing brought down her soaring fever, reduced her aches and pains or boosted her energy level.

It would be eight days before Gutiérrez went to Oaxaca's general hospital, where she arrived listless and barely able to breathe, her extremities blue from a lack of oxygen.

That delay in getting expert help may explain why Gutiérrez, 39, a mother of daughters ages 10, 17 and 20, became Mexico's first death from a new, virulent strain of influenza A (H1N1). It may also explain why Mexico's death toll from the virus is higher than anyplace else's.

Epidemiologists are still puzzled by the virus, its origins and its modes of transmission. But they agree that prompt medical attention is crucial to treating it. That has been where Mexico, which has had 12 confirmed deaths due to the new virus, lags far behind. A number of other deaths may have been caused by influenza A.

“People wait too long to go to doctors,” said Dr. Marcelo Nogera, undersecretary of health for Oaxaca state. “That's a problem here in Mexico. If we can treat a disease like this early, we can stay ahead.”

There may well be other factors to explain why patients in Mexico like Gutiérrez, whose medical records show a desperate, belated scramble by a team of doctors to keep her alive, are dying at what appears to be a higher rate than swine flu patients elsewhere.

Researchers speculate that one reason some of the Mexicans died was that they had other major health problems.

But medical officials say the most important factor may be the eclectic approach to health care in Mexico, where large numbers of people self-prescribe antibiotics, swear by homeopathic medicine or seek out vitamin injections. For many, only when all else fails do they go to a doctor.

“I think it has to do with the culture, the idiosyncrasies of Mexicans,” said Dr. Nicolás Padilla, an epidemiologist at the University of Guanajuato. “The idea is that I don't go to the doctor until I feel very bad.”

There are logistical reasons, as well, that compel Mexicans to steer clear of hospitals. At overcrowded public facilities, they complain, they are often turned away, treated by indifferent doctors or made to wait endlessly.

In the case of Gutiérrez, it took her three days to go to a doctor at a small clinic near her home. She was told she had a throat infection and should take antibiotics. As her condition worsened, she sought other opinions but still avoided the hospital. On her third consultation, a doctor told her she had pneumonia and sent her to the hospital.

Once she was admitted, health officials appear to have acted quickly. A laboratory test found an unusual virus.

The ward she had shared with at least 20 seriously ill patients was quarantined. State and federal health authorities were notified.

“She wasn't responding,” said Yuri Roldán Aragón, one of the team of doctors who struggled to figure out what was ailing her as they kept her alive with respirators and intravenous feeding.

But her condition worsened by the day, and she died the afternoon of April 13.

She was buried the day she died – odd in Mexico, where a wake is customarily held overnight, with burial the next day. Rumors had circulated that she died of a very contagious disease.

Her medical file, an inch thick, sits on the desk of Dr. Jesús Salcedo, the hospital administrator. Her various diagnoses over the course of her treatment – pneumonia, coronavirus, SARS, among others – indicate the initial uncertainty about her condition.

Gutiérrez's husband, Luis, said that when she arrived at the hospital, no bed was available, nor was a respirator.

And because it was Holy Week, the hospital had lower staffing levels than normal.

“A hospital shouldn't just be a building,” said Gutiérrez, a welder. “It needs medicines and people, too.”

Mexico's public health budget is about 3 percent of gross domestic product – within the range of spending by other major Latin American economies, but well below the rate in developed countries, according to the World Bank. Mexico has 1.6 hospital beds for every 1,000 people, a ratio half those of Brazil and the United States.

Three days after Gutiérrez died, Mexican officials declared an epidemiological alert based on her case and other strange deaths elsewhere in the country. That set into motion surveillance at 520 hospitals nationwide. The U.S. Centers for Disease Control in Atlanta also was notified of an expanded flu season.

On April 22, Mexico received notice of two cases from Southern California that showed components of swine and human flu. Two days later, Mexican authorities sent samples, including ones from Gutiérrez and a young boy in La Gloria, a small town in Veracruz, to the National Health Microbiology Laboratory in Winnipeg, Canada. The results came back the next day. Both Gutiérrez and the boy, Edgar Hernández, who survived, tested positive for swine flu.

Epidemiologists in Oaxaca then swung into action. They isolated Gutiérrez's husband and children, disinfected her home and began 500 interviews with neighbors, hospital workers and patients and other people she came into contact with as she went door-to-door in a temporary job with Mexico's tax collection agency.

Her family said that in her last days, Gutiérrez worked closely with another temporary employee who had a bad cough.

People who had flulike symptoms were tested, but none has been found to have the same virus that killed Gutiérrez.

Oaxaca, one of the country's poorest states, has reported about 60 suspected cases of swine flu. Gutiérrez is the only confirmed death.

“We're in a quandary,” Nogera said of how Gutiérrez might have contracted the virus while others around her did not.